N.Y. Comp. Codes R. & Regs. tit. 18 § 512.4

Current through Register Vol. 46, No. 45, November 2, 2024

Section 512.4 - Use of prospective drug utilization review program data

(a) Information which pharmacies provide through EMEVS will be stored for on-line retrieval and other pharmacies will have access to the information.

(b) The department's use of information obtained through the prospective drug utilization review program will include, but need not be limited to, the following:

(1) an analysis of an MA recipient's drug use patterns for post-payment audit review purposes and potential recipient restriction action; and

(2) an analysis of drug ordering patterns by MA providers for purposes of conducting MA provider audits and reviewing quality control standards used by the provider.

(c) Information which the department provides to pharmacies through EMEVS will allow pharmacists to perform prospective drug utilization reviews. Information provided to pharmacies may include the fact that that the drug ordered was previously dispensed within a certain time period, that a drug similar to the drug ordered was dispensed within a certain time period, and that the drug ordered is incompatible with another drug or drugs which have previously been dispensed to the MA recipient.

(d) The pharmacist may take appropriate action to rectify identified drug therapy irregularities, when necessary, based on the pharmacist's professional judgment. Such action may include, but need not be limited to, the following:

(1) consulting with the ordering practitioner;

(2) counseling the MA recipient; and

(3) refusing to dispense the drug or drugs.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 512.4